Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 20790 | MA |
N | 1223P0106X | Oral and Maxillofacial Pathology | DEN02806 | RI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 222855 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD11581 | RI |
NPI | 1568410983 |
---|---|
Provider Name | Dr. Mohammad Banki |
First Address | Warwick, RI 02888-3818 |
Second Address | Warwick, RI 02888-3818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U96350 | (02) |